Provider Demographics
NPI:1215001003
Name:DELLATORE, RITA FABRA (LCSW)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:FABRA
Last Name:DELLATORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 FORT DENAUD RD
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-6634
Mailing Address - Country:US
Mailing Address - Phone:863-675-7038
Mailing Address - Fax:
Practice Address - Street 1:2470 FORT DENAUD RD
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-6634
Practice Address - Country:US
Practice Address - Phone:863-675-7038
Practice Address - Fax:863-675-7048
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW67301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical